Evaluation of CT and MRI Imaging Results of Radicular Cysts, Odontogenic Keratocysts, and Dentigerous Cysts and their Contribution to the Differential Diagnosis

Background: The differentiation of various odontogenic cysts-specifically radicular cysts, odontogenic keratocysts, and dentigerous cysts-poses a significant challenge in clinical practice.Aim: This study aimed to evaluate the contribution of the MRI and CT results to the differential diagnosis of histopathologically different odontogenic cysts (radicular cysts, odontogenic keratocysts (OKCs), and dentigerous cysts.).Methods: A retrospective analysis was conducted on 60 odontogenic cyst patients (25 radicular cysts, 20 OKCs, and 15 dentigerous cysts) treated at Abbasi Shaheed Hospital and Ayub medical complex hospital where the study took place from 2020 to 2024.The lesion size, location, shape, margin characteristics, internal structure, and effects on surrounding structures were evaluated from CT and MRI imaging data.For objective evaluation of bone and soft tissue involvement, CT was used primarily, while MRI was employed for assessment of soft tissue extension and internal cyst content.Results: The most common radicular cysts were unilocular radiolucencies with well-defined cortex, frequently associated with root resorption and tooth displacement.Multilocular lesions with scalloped borders, internal septations and profound cortical expansion and thinning were present as OKCs.Dentigerous cysts tended to be unilocular, related to unerupted teeth and dislocate tooth with minimal cortical involvement.However, CT had strong ability to detect bone changes in all cyst types, while MRI was better at evaluating internal structure, internal structure and its association with soft tissues in OKCs.Conclusion: CT and MRI imaging comprise a pair of basic and indispensable tools for the differential diagnosis of odontogenic cysts.CT is effective at diagnosing both radicular and dentigerous cysts, whereas MR imaging plays a useful adjunctive role in the diagnosis of OKCs, owing to their aggressive nature and multilocular structure.However, these imaging modalities offer critical information for appropriate diagnosis, treatment planning, and management especially for more aggressive lesions such as OKCs.